Women diagnosed with breast cancer who previously breastfed their babies had a 30 percent overall decreased risk of the disease recurring, according to a new Kaiser Permanente study published in the Journal of the National Cancer Institute. In addition, researchers found that the protective effect of breastfeeding was more pronounced for tumors of particular genetic subtypes, including the most commonly diagnosed of all breast cancers.
The study involved 1,636 women with breast cancer who completed a questionnaire that included breastfeeding history. Additional medical data were obtained from medical chart reviews and Kaiser Permanente HealthConnect®, a comprehensive electronic health record.
"This is the first study we're aware of that examined the role of breastfeeding history in cancer recurrence, and by tumor subtype," said Marilyn L. Kwan, PhD, research scientist with the Kaiser Permanente Division of Research and lead author of the study.
The researchers found there to be benefits of breastfeeding on expected outcomes among women who were diagnosed with the luminal A subtype of breast cancer, while no significant associations were observed for those with other subtypes. Luminal A tumors include the estrogen-receptor positive (or ER+) breast tumors, which are the most commonly diagnosed of all breast cancers. These tumors are less likely to metastasize, are treatable with hormonal therapy such as tamoxifen and aromatase inhibitors, and generally have better outcomes.
In addition to decreased risk of breast cancer recurrence, women who breastfed were also 28 percent less likely to die from the disease.
There are a number of possible explanations for why breastfeeding could be associated with a better prognosis once a woman is diagnosed with breast cancer.
"Women who breastfeed are more likely to get the luminal A subtype of breast cancer, which is less aggressive, and breastfeeding may set up a molecular environment that makes the tumor more responsive to anti-estrogen therapy," Kwan said.
It is not entirely clear why women who breastfeed develop less aggressive tumors.
"Breastfeeding may increase the maturation of ductal cells in the breast, making them less susceptible to carcinogens or facilitate the excretion of carcinogens, and lead to slower growing tumors," explained Bette J. Caan, DrPH, senior research scientist with the Kaiser Permanente Division of Research and senior author of the study.
It is well established that breastfeeding is great for babies, Kwan noted, and research is now showing that it also has benefits for moms. "In fact, the protection was even stronger for women who had a history of breastfeeding for 6 months or more."
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This study is part of Kaiser Permanente's ongoing efforts to understand the complexities associated with breast cancer and improve care. Last year, Kaiser Permanente researchers found that patients with specific HER2+ breast cancer tumors have a low risk of the cancer recurring five years after diagnosis. In addition, in 2013 researchers found that patients who consume high-fat dairy products following breast cancer diagnosis increase their chances of dying from the disease years later.
In addition to Kwan, co-authors of the study were Bette Caan, DrPH, Candyce H. Kroenke, MPH, ScD, Laurel A. Habel, PhD, Erin K. Weltzien, Erica P. Gunderson, PhD, MS, MPH, RD, Adrienne Castillo, MS, RD, Charles P. Quesenberry, PhD, and Lawrence H. Kushi, ScD, of the Kaiser Permanente Division of Research; Philip S. Bernard, MD, Rachel E. Factor, MD, MHS, Inge J. Stijleman, and Carol Sweeney, PhD, of the Huntsman Cancer Institute, University of Utah; and Bryan Langholz, PhD, of the Department of Preventive Medicine, University of Southern California.
This study was funded by the National Institutes of Health, with additional support from the Huntsman Cancer Institute.
About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR's 500-plus staff is working on more than 400 epidemiological and health services research projects. For more information, visit http://www.dor.kaiser.org or follow us @KPDOR.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve approximately 9.6 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to kp.org/share.
Journal
JNCI Journal of the National Cancer Institute